Helping at home is part of Mary Landrieu's job: Stephanie Grace

After finally cobbling together the votes to pass a giant health care reform bill, the Senate's exhausted Democratic leader offered an unusually blunt rationale for the many deals he cut to get there.

"There's 100 senators here, and I don't know if there's a senator who doesn't have something in this bill that's important to them," Nevada Sen. Harry Reid said. "If they don't have something in it important to them, it doesn't speak well of them."

For all the professed horror that horses were traded and politics were played, Reid's got a point.

Senators bargain for concessions all the time, on all sorts of bills. And one could certainly argue that those who don't are falling down on the job.

Which brings us to Mary Landrieu.

Landrieu's taken a good amount of heat for landing $100 million to $300 million to help close a huge Medicaid funding gap for Louisiana -- the result of a flawed formula that lumps hurricane recovery money in with income -- and then declaring her support for the health bill. For her trouble, she's been labeled everything from a Judas to a prostitute.

Pedro Martinez Monsivais/The Associated PressSen. Mary Landrieu, D-La., center, is surrounded by reporters after a news conference on the health care bill Dec. 9. The senator became a major player in the health care overhaul.

For the record, Landrieu says she didn't trade her vote. But even if she did, or if the Medicaid fix was one factor in her decision to back the bill, the fact is that that's what she always said she'd do.

Landrieu could never be confused with a big ideas politician, one who aspires to drive policy on national security or domestic issues like health care. Her priority, as she made clear during her victorious 2008 campaign, is to leverage her seniority and her status as a swing vote for her state.

If she used that leverage to craft a solution to a real Katrina-related problem that the Obama administration should have fixed anyway -- a top priority, by the way, of Republican governor Bobby Jindal -- that's certainly more defensible than what some of her colleagues did.

Take Ben Nelson of Nebraska, who got his state exempted from paying for the bill's Medicaid expansion, a $100 million concession over 10 years. Another Nelson, Bill from Florida, pushed a provision to allow 800,000 seniors in his state to keep their expanded Medicare Advantage benefits.

Then there's Chris Dodd, who managed to get $100 million for a new teaching hospital written into the bill -- something else that's on Louisiana's wish list, but will presumably go to Connecticut instead. Kind of makes you wish Landrieu had held out for that, too.

Meanwhile, senators who didn't drive a hard bargain may have some explaining to do back home, as Reid suggested.

"If you're going to cave, why get so little for your state in return?" the Arkansas Democrat-Gazette's editorial page asked after Sen. Blanche Lincoln voted for the bill. "That ought to be the first question Arkansas voters ask Senator Lincoln when she comes around asking for our votes next year."

By the way, Landrieu's not the only Louisiana senator who knows a little something about leverage. Sen. David Vitter, who called Landrieu's vote a "Louisiana Sellout" on the Senate floor, has also made a habit of using the tools at his disposal to get his way.

Since Vitter almost never strays from the Republican Party line, he can't very well bargain for his vote. Instead, he relies on a procedural instrument: The ability of any single senator to hold up confirmation of an administration official.

With hurricane season approaching, Vitter held up Craig Fugate's confirmation to head the Federal Emergency Management Agency until FEMA revised a rule that was delaying construction of public projects in vulnerable coastal areas such as Grand Isle and Cameron Parish.

More recently, he delayed confirmation of the Environmental Protection Agency's incoming research and development director to secure a commitment that the National Academy of Sciences be allowed to review the EPA's formaldehyde assessment before instituting new safety standards, a position advocated by the formaldehyde industry.

One could certainly argue that all of this backroom maneuvering taints the process. Still, like it or not, it's how the game works.